Understanding your semen analysis - what really matters?

The semen analysis is the foundation for a workup for male fertility. Unfortunately, it is by no means a perfect diagnostic test and a “normal” test is relative. There can be considerable variability between semen tests obtained in the same person at different times. This variability can exceed 400%. In comparison, variability for certain diagnostic blood tests is within 20%. Therefore, I usually recommend obtaining more than one semen analysis if there are abnormalities on the first one. Even in the most severe cases of male infertility (men with absolutely no sperm seen in the ejaculate (azoospermia)), a repeat semen analysis would be recommended especially if not performed at a high-volume fertility center. We sometimes see men who have been told that they have no sperm in the ejaculate from an outside test, where a repeat semen analysis at our lab finds some sperm.

The results of the semen analysis can be overwhelming for many couples. My goal is to breakdown this complicated diagnostic test and provide a framework for understanding your prognosis.    

Total motile count:

Total motile count is considered the most important semen parameter and one of the best predictors of fertility potential. This number is the absolute number of millions of swimming sperm. Male fertility potential is generally a numbers game. The more sperm that is present in the ejaculate (specifically the higher the total motile count) the higher likelihood of achieving pregnancy either naturally or with artificial reproductive technologies (IVF). But remember that even a single sperm can get the job done. Optimization from the male side typically involves improving the total motile count in an effort to improve chances of conception.

Some couples will ask to distinguish between progressive and non-progressive motility which is usually reported as a percentage. Progressive motility refers to the percentage of motile sperm that can swim in a straight line or a large circle compared to non-progressive motility refers to the percentage of motile sperm that cannot swim in a coordinated fashion or swim in tight circles. This distinction is not as important as the total motile count and generally from the couple’s perspective can be ignored.               

Morphology:

Abnormal morphology tends to cause the most distress for couples. This is the most subjective criteria and basically describes the percentage of absolutely perfectly shaped sperm (symmetric oval shaped head and single long tail). The criteria for normal morphology is very strict. Strict enough that even in most fertile men, >90% of their sperm have abnormal morphology. Even in men with 0-3% normal shaped sperm (abnormal morphology), most experts would agree that the role of abnormal morphology predicting pregnancy is limited, and generally from the couple’s perspective can also be ignored. Many couples incorrectly assume that abnormal morphology can lead to physical or mental birth defects, however that is simply untrue and there is considerable evidence to back that up.         

Ejaculate volume:

Lastly, I will touch on ejaculate volume. Generally, low ejaculate volume (<1.5 mL) may suggest a form of obstruction or ejaculation issue (retrograde ejaculation) that can lead to no or low counts of sperm in the ejaculate. More commonly, however, other factors may explain low ejaculate volume such as abstinence time prior to the test (time since your last ejaculation) and ensuring that the entire sample was collected within the specimen cup. For these reasons and those mentioned previously, in men with low ejaculate volume, a repeat semen analysis is usually warranted.

The results of a semen analysis should be evaluated collectively rather than focusing on individual parameters. This often requires interpretation by a male fertility doctor. As access to semen testing improves through direct to consumer platforms or through large commercial labs, it is important to seek out a male fertility doctor to help put the results in content. As a male fertility expert, my goal is to help optimize your chances of conceiving naturally or success with artificial reproductive techniques (IUI/IVF) through identifying and correcting reversible causes of male infertility.

-Dr. Patel